A New Kid on the Bloc

A new kind of agency is emerging out of the cries for transparency and concern that CRNAs are working for the same pay as ten years ago.  Yes, we have seen some recent movement in the pay of CRNA locum providers in the past year. However, it still seems our pay is sometimes below or at that of w-2 providers with benefits factored in.   Part of this slight increase could be attributed to the education of providers and the demand for CRNAs to fill gaps as anesthesia management groups grow. 

BlocHealth is trying to prove a transparent model of bringing together platforms of providers searching for competitive but higher rates and groups/hospitals looking to decrease agency fees and overall hourly fees for the temporary workers. Win for both the client hospital or group and the contractor/provider.  This matching process is still a growth project where they are actively searching for exactly what our providers are looking for in the areas they are looking.  This could branch out into a system whereby “Employers” are independently contracting “Providers” through a web-based matching system and negotiating a contract more completely on-line.  Part of this may include a more automated credentialing platform where provider data is streamlined to the requesting hospital expeditiously.  Although there is no completely automated system, at this time, for the job-seeker and employer.  However, BlocHealth is an agency right?  Sure enough, they are an agency and their fees are still in place.  However, using an automated process and setting in motion an atmosphere of a less hands-on approach will allow for lower overhead and expense ratios.  What’s that boil down to?  Sometimes this is less than 1/3 the fees of a standard agency. 

I believe that this will put some of the credentialing process on the provider as there will initially be less funneling of paperwork to the hospital as a larger agency might initially do. This means credentialing would be of some effort on the part of the client.  We’ve all done this paperwork 100 times and have given the same information to either hospitals or agencies before.  This time it’s to get the rate you want and possibly the area you want to work in.   I believe that as the process grows this automation will decrease the paperwork burden. 

They are also up front in saying that at this point they want providers to state realistic rates, time-frames, skill–sets and areas of desired work.  Then BlocHealth is looking for positions that will fit the provider and group.  Where-as most agencies advertise positions open in hopes of getting a CRNA to fill them.  This may be known places that need help or calling in the region to see if groups are in need or struggling. 

Overall, I see intriguing changes for the future that could grow into a good niche with-in the locum world. 

Why do I say all this?  I called and talked to them.  I tried to understand the company dynamic and what it could be.  I put them up on the site and have a referral contract with them and want to know that they are trying to be clear and work for the follow through.  I even filled out my information on their site and found the process to be just about as easy as any other. 

I almost able to do all the paperwork on my phone.  Recently, I was told BlocHealth now has a convenient and easy way of accessing a personal folder on the cloud that contains all provider information in one place. 

I may just work with them in finding contracts for other CRNAs in the future. 

Students

SRNAs:  Because this comes up several times per month and I had an experienced CRNA ask me my thoughts.  Some will say they are appalled I would state this and some would back it 110%.  I'm going to explain the perceptions and then the exceptions and leave it out there.  

Seasoned CRNA: 

I didn't think most agencies would hire new grads.

Me:

No they typically won't. A few reasons and I don't say it to be mean. 1) most are wanting to credential before passing boards. They can't do that because a provider must be qualified to practice in order to be credentialed.  A facility hiring a new grad may go through all the steps of credentialing pending boards and licensure but both boards and licensure take time post graduation. Then the credentialing office verifies those two things and your off to the races.  Unfortunately, locums the facility can't guarantee you will pass boards and be licensed and therefor the same dilemma of time between graduation and taking a first job exists.  2) The SRNA pending CRNA isn't proven safe in an established practice for a period of time. If they have been in practice less than 3-6 months were they let go from a facility for cause either interpersonal dynamics or poor practice?? 3) Locums are used because a facility or practice is short of help and needs someone that has developed their practice and can jump in and provide skilled care in less than optimal conditions. 4). It can be hard to go from student mode to alone especially if most or all your education and training was 1-1 with someone always there.  This transition is helped by going to a practice that has people that can facilitate the growth from student role to provider role.  I believe this can be established in any role but some are definitely more challenging than others.  

For example some ACT keep CRNAs in a very restricted environment that can be more of a hindrance so the CRNA fully develops all of their skills.  Other ACT environments use CRNAs to their capacity but have the Medical Direction model and each does their part in a collegial practice.  Some CRNA only or private groups where both MDAs and CRNAs work on independent cases will say that you are a CRNA and should do only what you know.  Others will teach and build you up to the full capacity of that practice.  Still some only do a certain type of practice, which they are excellent at. However, they lose other skills and if branching out find a difficulty in full scope of practice. Solo practice... Most say a highly skilled CRNA of at least 5 years practice should go to these places.  This depends on training and the experience they had in 5 years.  If they have been doing blocks, spinals, epidurals, lines, kids, adults, critical to fast paced out patient for 5 strong years. That's what the solo practice is looking for along with someone that wants to learn and grow as a provider.  Really, this is what a locum agency and average short-handed facility would like too.

Am I saying that new grads have not gone directly into locums or solo practice?  Nope.  Am I saying they are poor providers? No.  I'm saying that it's not recommended and many agencies will discourage the practice of locums for new graduates.  Most request 1-2 years of practice to be comfortable in your role and discussing with medical staff regarding patient care.  

If you feel I've missed something please e-mail me and I am happy to edit this.  LocumCRNAs@gmail.com

Pain and Nausea

As a locum anesthesia provider I like to try different anesthesia groups cocktails for pain and nausea.  I have yet to see one that uses alternative therapies like inhalation, acupuncture, or acupressure.  I just don't see them very often.  I was approached on Linked In about a product and them wanting to put it up as a blog post.  I can't say that I have used or endorse the product as I am just learning about it. Information and being able to know about it if/when it becomes popular is nice.  So here is the information which I was provided. I will include the picture and this is what was written by Joseph.

United Behind the Best PONV Management Choices  

Postoperative nausea is still commonplace in patients following surgery. Nausea drug therapy recommendations for multi-modal use associated with surgical procedures have proven less than optimal. Clearly, prophylactic antiemetic drug combinations have not been always adequate enough to prevent and/or treat existing early and late postoperative nausea.

The decision-making process to shore up the foundation of pharmacological choices for postoperative nausea and vomiting (PONV) management could use a new course of direction that allows for the inclusion of non-pharmacological treatment strategies to achieve widespread optimal prevention results.       

One such choice is the non-pharmacological prophylactic antiemetic practice of the (P6) pericardium pressure point for preventing nausea/emesis in surgery patients practiced by Eastern medicine surgeons. Eastern medicine relies heavily on strict adherence to an effective scientific process involving 360 acupoints in the human body.

For example, the practice of the P6 pressure point seems more readily adaptable in a surgery patient’s environment compared to drug therapy because of its continuous acupoint stimulation process, which is believed to provide for the normalization or re-establishment of the balance of the body’s function related to the stomach and central and peripheral nervous system resulting in optimal management of PONV.

The Pressure Right® non-pharmacological prophylactic antiemetic adhesive device provides the P6 effect for achieving optimal PONV management results. Its locum use in combination with drug therapy can either be implemented prior to the induction of anesthesia or as a treatment strategy. The device’s stimulation process takes effect within 5-minutes and its antiemetic effect can last up to 3-days or 72-hours, which is considered the longest prescribed routine antiemetic effect on the market today.

As a point of reference, the unusually high incidence of PONV associated with aesthetic plastic surgery and laparoscopic patients were dramatically reduced with Pressure Right used in combination with routine antiemetic drug therapy. With aesthetic plastic surgery, no emesis at all and very rare nausea was reported. Furthermore, in laparoscopic clinical trialing of Pressure Right there was only very rare emesis and nausea reported after surgery. In addition, there have been no reported adverse side effects associated with this device. 

Pressure Right has pre-market approval from the USFDA as a prescribed non-pharmacological acupressure nausea/emesis therapy device. It is intended for adult use 18 years and older and is a non-invasive, hypoallergenic and latex-free, pair of adhesive strips to be worn on both wrists. The adhesive strips are designed not to go completely around the patient’s wrists and will not interfere with the surgical procedure.     

Ask about our 7-patient sample package; whereby, Certified Registered Nurse Anesthetists as well as Surgeons and the nursing staff will be able to recognize the immediate and optimal antiemetic effect of Pressure Right. Applying Pressure Right as a treatment strategy for established PONV will demonstrate its optimal effectiveness on patients almost immediately.    

Contact us about Pressure Right. A new form of optimal PONV management awaits you.

Contact: Joseph DiLustro, CEO, Pressure Point Inc. for additional details at:

Email: therapeutics101@verizon.net

Phone: (908) 601-8877 

Wrist Acupuncture Or Acupressure Prevents Nausea From Anesthesia, Review Finds

Date:

April 16, 2009

Source:

Center for Advancing Health

Summary:

Up to 80 percent of patients who have surgery complain of nausea and vomiting afterwards, but stimulating an acupoint in their wrists can help reduce these symptoms, finds a new evidence review.

Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.

Lee A1, Fan LT.

Author information

Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. annalee@cuhk.edu.hk

Update in

Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. [Cochrane Database Syst Rev. 2015]

New Policy Availability at Canyon Clifton

We are excited to introduce a new exclusive program for part time/moonlighter CRNA’s, exclusive to Clifton Insurance Agency, Inc.

General Star Indemnity, an A++ Superior Rated Carrier and the Clifton Insurance Agency are proud to announce a TWO-YEAR Policy with UNLIMITED TAIL. This is the first policy of its kind.

Clifton Insurance Agency has been in business since 1982 and we strive to be the best. We are family owned and operated and we treat every client as if they are family.

General Star Indemnity (part of the Berkeley Companies) has been in business since 1980 and is rated A++ Superior by A.M. Best, there is no higher award given to an insurance carrier. They boast an XV Financial Size ($2,000,000,000 or greater).

Pricing:  $2,775.00 plus State Tax ($3,000 or less, total), for two years and the unlimited Tail. One application for two years, and affordable – what more could ask for?

Coverage Highlights

-Up to $1,000,000/$3,000,000 limits of Liability

-$0 Deductible

-Consent to Settle

-Defense Outside the Limits- $1,000,000/Aggregate limit

-Policy Flexibility- no worries about county restrictions

-Prior Acts at NO additional charge

States:

Texas, California, Idaho, North Carolina, North Dakota, Arkansas, Minnesota, Iowa, Maine and Vermont.

Other States are also considered so please do reach out to us…

-As you can imagine, we are quite busy. While we enjoy the capability of social media, our time is better served tending to our clients. If you are interested in the new program, please contact our Program Director, Cooper Clifton. He designed the program so he can answer any questions. 877-212-4368 Ext: 103. 

                cooper@cliftoninsuranceagency.com

https://www.cliftoninsuranceagency.com/medical-malpractice-insurance/crna-malpractice-insurance/

Cheers!

The Clifton Insurance Agency, Inc.

Staying up to date

If anyone is like me and had to replace a credit card and that is how your membership is renewed on the AANA site.... check to make sure your Membership in-fact renewed.  Mine has yet to be renewed as that happened.  However, the E-mail says we have until October 31 so I'm trying to make sure I pay my dues right away and don't incur interest on the credit card.  

I hop you have been looking around on the website and been able to find pages like the state meetings, financial education, CEU, and even some of the job listings mentioned.  Not to mention seeing how to support us as we aren't charging for job posting, meetings, CEU companies as all are CRNA based and working constantly to improve the site!  

We'll be updating the mortgage and qualifying information as there is much more to learn on how things are affected by 1099 work.  

Insurance page is still coming soon as I continue to ask some of the top advisors for more information on how to best give more information.  

I continue to try and make this site for you.  if you have more questions... e-mail me at LocumCRNAs@gmail.com

Insurance Admitted vs non admitted

Confusion sometimes arises about the difference between “admitted” and “non-admitted” insurance carriers and about the consequences of the difference. The designation of an insurance company by a state’s Insurance Commissioner as “admit­ted” may seem to give the company a stamp of authority, but this designation is primarily an administrative one rather than a mark of quality or stability. Other factors should be more important in the choice of a carrier.

Let’s take a close look at what admitted v. non-admitted really means.

What is an “Admitted” Insurance Company? – An admitted carrier is often referred to as a “standard market carri­er.” To qualify as an admitted carrier, an insurance company must file an application with each state’s insur­ance commissioner and be approved. Approval requires compliance with a state’s insurance requirements, including the filing and approval of that company’s forms and rates. This process often takes a long time.

Once a carrier is licensed to transact insurance business in a certain state, the carrier is required to pay a portion of its income into the state's insurance guaranty association. One of the main selling points of being an admitted is that the carrier’s liabilities are backed by that state’s “guaranty fund.” If an admitted company becomes insolvent, the state will help pay off policyholders’ claims. 

What is a “Non-Admitted “Insurance Company?  – A non-admitted carrier is often referred to as an “excess and surplus line carrier” and operates in a state without going through the approval process required for admitted companies. Non-admitted carriers are not bound by filed forms or rates and therefore have much greater flexibility to write and design policies to cover unique and specific risks, and to adjust premiums accordingly. When standard markets can’t or won’t write a risk, or when an admitted carrier cannot offer the appropriate terms, the non-admitted market is available to fill this gap.

Non-admitted insurance carriers are regulated by the state Surplus Lines offices, but regulation is far less invasive than for the admitted markets. The most obvious difference between admitted and non-admitted is that purchasers of non-admitted policies do NOT have the protection af­forded by the state’s guaranty fund. Each state does charge taxes for non-admitted insurance, and agents must be licensed in surplus lines to sell non-admitted insurance.

The designation as “non-admitted” should not be taken as an indication that these insurance carriers aren’t legitimate or financially stable. In fact, to sell surplus lines insurance, non-admitted insurance companies have to set aside a large monetary reserve or secure adequate re-insurance.

Insolvency – When an insurance commissioner determines that an insurance company is having significant financial difficulties, the insurance company will go through a process called “rehabilitation.” The state’s insurance commissioner will make every attempt to help the struggling company regain its financial footing. If the company cannot be rehabilitated, the company is declared insolvent, and the court will order liquidation.

Liquidation of an Admitted Carrier – If the carrier to be liquidated is an admitted company, the processing/pay­ment of existing and future claims is taken over by that state’s guaranty fund. However, the guaranty fund’s obliga­tions are limited by regulations and will only pay claims up to that state’s cap.  In some cases, if insureds exceed a certain revenue threshold they may not quality for any guaranty fund coverage. 

Depending on the state, guaranty funds usually provide only $100,000 to $500,000 of protection per policy even if the policy had a much higher limit. Most states are at $300,000. In addition, if several liquidations take place in one state, the state’s guaranty fund may be depleted. Policyholders often only receive pennies on the dollar of their true loss amount from a guaranty fund.

While state guaranty funds try to pay claims as quickly and efficiently as possible, payments are often slow.

In sum, although the guaranty funds provide some level of comfort if a carrier becomes insolvent, in reality, policyholders can be left with little or no assistance.

Liquidation of a Non-admitted Carrier – If a non-admitted insurance company goes “belly up,” the liquidator/receiver collects the assets of the company, determines all the liabilities/creditors outstanding, develops a plan to distribute the company’s assets and submits the plan to the court for approval (much like a typical bankruptcy pro­ceeding). In most cases, the insurance company’s estate will not yield sufficient money to pay the company’s cred­itors (including their policyholders' claims) in full. Policyholders often have to fund defense and settlement payments themselves before they can request reimbursement from the estate. Usually, the policyholder will have to wait patiently and will,  again, only get pennies on the dollar.

The largest surplus lines writer in the U.S. is Underwriters at Lloyd’s, London. In 1925, Lloyd’s created the Lloyd’s Central Fund, which pays claims in case any underwriting member should be unable to meet his or her liabilities. Unlike the guaranty funds, the Central Fund does not have a cap. The only cap for the Central Fund is the policy limit. (Illinois, Kentucky and the Virgin Islands are exceptions because Lloyd’s is admitted there and is subject to the state guaranty funds.)

Bottom Line – The choice between admitted and non-admitted insurance companies is something that needs to be considered, but examining the financial strength of the individual providers, the breadth of coverage and competitiveness of terms is more important. The priority should always be to seek a high-quality provider, regardless of whether the company is admitted or non-admitted.

Taken from Laura Zaroski as approved by Canyon Clifton Insurance http://insurancethoughtleadership.com/admitted-v-non-admitted-whats-the-difference/

AANA Meeting

I wish I was able to meet everyone up in Seattle but this year is the new family time.  We have so many things we want to do each and every day it's just impossible to do all of them.  

I hope that all will make time for the vote and meetings as they are on-line this year!  

I am truly trying to make this site and blog helpful.  Help me make it standout as a site that others go to for solid information.  The only way to do this is to have people know that it exists and then to give feedback on how I can improve it.  

I have sent more than ten companies e-mails asking for tips, blogs, and information on how to help CRNAs in the tax, financial, mortgage, and insurance areas.  These areas are key to the financial health and well being of the independent/locum CRNA.  

I'm hopeful to get more and more information to you as I am able to get these very busy professionals to pass along their professional information.  I will continue to strive to give you excellent content and information as able.  

Please make time to go to the exhibits and tell locum agencies they can post their ads up so you can see what just applies to locums.  Also, give people both the Facebook and LocumCRNA.com site so that they can be involved and continue to learn.  

I look forward to hearing your experiences in the future.  

Labor Day Weekend

I hope most had an outstanding Labor Day!

its about time to start thinking ahead.  It is now September and the free fall to New Years is coming.  This month is mostly AANA state and national meetings.  October is Halloween. November is Thanksgiving and December Christmas/Hanukkah.  The year is going to be over!  

I say this because so many people tell me later, I'll do something later.  I'll diet next week.  I'll be ready for a change next year.  I'll organize my desk next weekend and 8 weeks has gone by.  I'll work on my solo401k vs checkbook IRA when I have free time.  I'll invest in real-estate when the perfect deal comes.  We'll have children when we are settled and debt-free.  The list goes on and on.  So... you want to talk about locum work and get started when?   

You pick a date just far enough away that something can come up.  Oh, the gas price went up so I couldn't do the paperwork for my business.  What???  Anyways, today's point is to please do something toward what you want. If you aren't actively doing something, you are dreaming.  When you do something you set things in motion and a follow up step is required.   

It's easier when you start.  

New Additions

Hello to all!!!

I'm working on getting more information on Insurances from Canyon Clifton as a blog post and then more information to feature on a page with-in the website here.  This way the information is readily available.  

I'm also working on a blog post from Matt at Mortgage Lenders of America on 1099 Mortgage loans and recommendations.  This will also be added to the blog and a separate page for future reference.  

I'm going to be reaching out to tax preparers and financial advisors for their input as well.  

Please keep an eye out for any information you would like to see added so this website is best for you!  

Busy Life

Can I just say how fast life is flying by?  I have been in Philadelphia a month and a half!  We are settled in and Rosie has broken 2 Leashes... it's a miracle the little Frenchie is not DEAD.  We live in the very busy downtown area of Philly and there are highways and significant throughways all around our apartment!!

We must be getting busy because we are talking about how busy we are and how much we have to do.  That usually means we are settled in a place and are just becoming cranky that life is catching up with us!  We love getting to do all these things here in the city but housework is not loved by anyone!  

So, when you decide you are going to locum.  You have to think about what you are going to do and how you will live in the city.  Francisco loved the hotel where they came to clean each and every day.  Life was totally different pre and post Elizabeth and the hotel was almost do-able before the little girl blessed us ... but now we move.... EVERYTHING EVERY TIME.  We plan for long term options and what we can do in the event things change.  

I have to look at what the best options are for us and where the opportunities exist.  We also look at cost of living.  We are also down to one car as our truck wouldn't fit in the parking garage here.  We only did this for a short time in Dodge City years ago but we had bikes and other activities in a small town.  Now we have lots of activities but two dogs, two of us, and the kiddo soooo we are again a little limited.  

The great thing is we are paying bills and getting ready to pay off the Jeep we have with us!  I'm so stinking excited.  Each month I see the total debt reduced in a significant way, I'm so happy.  It makes the amount of work worth while!  

Francisco is starting his food channel on YouTube and talking to me about the food truck again.  I think someday we might work on a restaurant but it will be so difficult to bring that into the mix.  

Just my thoughts on today!